Use LTRA tablets over combination therapy to control asthma, says NICE

GPs should prescribe LTRA (leukotriene receptor antagonist) tablets to patients earlier than they do in current practice, the guidance says.

NICE’s latest draft guideline on managing asthma, now up for consultation, recommends that patients newly diagnosed with asthma should be prescribed a short-acting beta2 agonist (SABA) as reliever therapy to use whenever they experience symptoms.

It advises that patients who regularly use their reliever to control symptoms should be prescribed a low-dose inhaled corticosteroid (ICS) for use as maintenance therapy.

But if symptoms continue to persist, NICE now recommends that patients should be prescribed LTRA tablets alongside ICS as the first-line option of managing symptoms – instead of other options such as combination inhaler therapy.

NICE researchers concluded that both treatments were clinically effective as step-up therapy – but the former can be funded at just 7p a tablet, making it a significantly cheaper and a more desirable first-line option.

Managing asthma

This could reap savings of £3m a year for every 10,000 patients treated under the new recommendations, NICE said.

Patients who still experience symptoms while taking LTRA therapy should then be offered combination inhaler therapy in addition to or instead of the tablets, the recommendations say.

Diagnosis of asthma is not covered in the guidance, and NICE says it is still in the process of working up a separate guideline on this.

It released draft guidance recommending a standardised method of diagnosis two years ago, but finalised publication was delayed following a mixed reception to the recommendations.

Professor Mark Baker, director of the NICE centre for guidelines, said: ‘With this new guideline we want to give clear guidance on how health professionals can help people take control of their symptoms so they can live life to the fullest.

‘Millions of people need treatment for their asthma which comes at a price. We also need to make sure that we make the best use of NHS resources and our guidance is the first to set out what the most clinical and cost-effective options for treating asthma are.

‘We recognise that these new recommendations represent a change to current practice. However it is a change that is likely to save the NHS millions each year.

‘We now want to hear from all those who provide care for people with asthma in the NHS to ensure that the views of those this guidance will affect are fully considered.’